Just-in-time strategies for when you're overwhelmed - MBBS

With MBBS approaching, its natural for stress to build up.

Stress on its own, isn't necessarily bad. It's the kind of energy that gets us going everyday to work towards our goals. It's the energy that reminds me that I'm not satisfied with where I am right now and I have lots of potential to improve.

But as medical students, we are all too familiar with being overstressed. When stress becomes the dominant daily experience, it can interfere with our focus, health mood, and extend outwards to impact our relationships, mindset and choices.

Obviously, stress is a large topic to explore. Here, I just want to focus on acute stress and just-in-time tools one can use to bring down our physical stress. I think doing so can help us think more clearly and respond instead of react.

I wrote this because that momentary panic during OSCE stations and ward presentations can often derail us and stop us from giving our best. I hope this post helps you put your best self forward 😃

These tools may not apply to everyone but from one anxious person to another, I hope it helps ground you in the present and perform to your best ability!

Slow down your breathing

• When we're stressed, our breathing often speeds up without us noticing it. Our minds are too anxious to focus on anything other than the next station.
• When we slow down our breathing, we're reminding ourselves that we're in control and we can respond instead of reacting by blurting out "Dieulafoy's lesion" as our primary differential.
• Takeaway:
  1. When you notice you're feeling ovewhelmed, steady your breath by counting the breaths in your head
  2. "In - 1", "Out - 2", "In-3" ....

Box breathing

• Box breathing is a popular breathing technique to calm down the mind and body
• It's very simple to do. All you need to do is inhale for 4 seconds, hold 4 seconds, exhale 4 seconds, hold 4 seconds and repeat.
• It can be helpful to imagine a box in your mind. Start from any corner and begin moving clockwise to the next corner for each phase.
• Takeaway:
  1. Inhale 4 seconds, Hold 4 seconds, Exhale 4 seconds, Hold 4 seconds. Repeat.
  2. Try it out for 2 minutes and notice how you feel after

Take in your surroundings

• Take a moment now to notice your surroundings. Where are you? How does the wind feel on your skin? Does it feel warm or cold? How are you sitting?
• Now notice how you feel. Do you feel any different?
• You may feel a bit more aware of your inner environment. You may also feel slighlty grounded and calmer.
• You may have also noticed that your attention wandered off mid-way. That's completely normal! When that happens, gently bring your attention back to your body.
• This is a physical grounding tool and helps to re-focus your attention. It's a helpful tool when your attention feels like it's being blown around by stressful thoughts or emotions.
• Takeaway:
  • How does your body feel?
  • What posture is your body taking?
  • Where is your breath?

Purposefully slow down your actions

• This may be hard to do within an actual station but it might help before you enter the room or in other scenarios.
• This exercise is similar to slowing down your breathing but its taken one step further for better immersion.
• When we're stressed, we often start rushing and moving even faster to get things done. That's a perfectly normal reaction but the trouble is it can sometimes cause us to do things without thinking.
• By purposefully slowing down actions, its a cue to notice what we're doing and change course if we're headed down the wrong road.
• Now, you don't need to simulate bradykinesia! Just a few notches slower than how you would normally go and then observe.
• Takeaway:
  • What are you doing right now?
  • What are you trying to achieve here?
  • Are your actions in line with your intentions?

y goal here is to outline real-time tools one can use to notice, observe and respond better.

I hope these tools help you take back some control of your real-time stress and hopefully, prevent you from being overwhelmed in the moment. Play around with these and see which ones work for you.
Acute stress is going to be a long-term companion in medicine. It's a great investment to learn how to be with acute stress as it arises.

In my next post, I'm going to write about long-term stress, how it differs from acute stress and it's long-term impact. In the meantime, have fun with these tools and take care of yourself 😃

Feel free to reach out if you have any suggestions, spot any errors or just want to chat!
[email protected]

Further readings:

• Breathing exercises from Headspace
• A Liberated Mind by Steven Hayes
• The Happiness Trap by Russ Harriss
• What is box breathing?
• Box breathing and other relaxation techniques